Public reporting states have low angioplasty rates

By Piriya Mahendra, medwireNews Reporter

US states in which public reporting of percutaneous coronary intervention (PCI) rates by catheterization laboratories is required may have a reduced rate of the procedure in acute myocardial infarction (AMI) patients, research suggests.

However, investigators led by Karen Joynt (Harvard School of Public Health, Boston, Massachusetts, USA) found no significant difference in AMI mortality between states that participate in public reporting and those that do not.

The authors say that there may be two reasons why public reporting leads to underuse of PCI. First, they suggest that the majority of the foregone PCI procedures may have been futile or unnecessary, and that public reporting leads clinicians to ensure that only the most appropriate procedures are performed.

Alternatively, they say, public reporting may encourage clinicians to avoid PCI in eligible patients due to concern over the risk for poor outcomes. "Our data cannot definitely differentiate between these two mechanisms," Joynt and team explain.

Specifically, they found that in 2010, AMI patients were significantly less likely to receive PCI in the public reporting states of New York, Massachusetts, and Pennsylvania, than in the nonpublic reporting states of Maine, Vermont, New Hampshire, Connecticut, Rhode Island, Maryland, and Delaware, at 37.7% versus 42.7%.

The difference in PCI rate was greatest among the 6708 patients with ST-segment-elevation MI and the 2194 patients with cardiogenic shock or cardiac arrest than the other patients, at 61.9% versus 68.0% and 41.5% versus 46.7%, respectively.

Joynt et al found that before Massachusetts began public reporting in 2005, the risk for PCI in AMI patients was comparable with the risk for PCI in nonreporting states, at 40.6% versus 41.8%. However, in 2010, the risk for undergoing PCI was significantly lower in Massachusetts than in nonreporting states, at 41.1% versus 45.6%.

Again, the difference in PCI rate was most pronounced among patients who had experienced cardiogenic shock or cardiac arrest, at 44.2% versus 36.6% before reporting began, and 43.9% versus 44.8% afterward.

In a related commentary, editorialist Mauro Moscucci (University of Miami, Florida, USA) writes: "The study by Joynt et al confirms the possible unintended consequences of public reporting, while highlighting its association with (or lack of association with) clinical outcomes."

He concludes: "These findings may help spearhead a new focus on procedures that, while perceived appropriate based on current use criteria, might not result in added benefit in selected patients."

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